Provider Demographics
NPI:1831574243
Name:GLENHAVEN HEALTHCARE, LLC
Entity type:Organization
Organization Name:GLENHAVEN HEALTHCARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:S
Authorized Official - Last Name:KARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-484-0784
Mailing Address - Street 1:212 W CHEVY CHASE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2318
Mailing Address - Country:US
Mailing Address - Phone:626-314-3604
Mailing Address - Fax:626-421-6766
Practice Address - Street 1:212 W CHEVY CHASE DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2318
Practice Address - Country:US
Practice Address - Phone:818-240-6720
Practice Address - Fax:818-247-3942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA555605Medicare Oscar/Certification